v THE PROGRESS OF MEDICINE AT ST. BARTHOLOMEW'S HOSPITAL. 1123-1888. EX LIBRIS 1ARVEY CUSHING YALE MEDICAL LIBRARY HISTORICAL LIBRARY THE PROGRESS OF MEDICINE ST. BARTHOLOMEW'S HOSPITAL. AN ADDRESS DELIVERED AT THE OPENING OF THE SESSION OF THE ABERNETHIAN SOCIETY, OCTOBER 16th, 1888. NORMAN MOORE, M.D., F.R.C.P., ASSISTANT PHYSICIAN TO ST. BARTHOLOMEW'S HOSPITAL; WARDEN OP THE COLLEGE AND LECTURER ON PATHOLOGICAL ANATOMY TO THE HOSPITAL ; ASSESSOR TO THE REGIUS PROFESSOR OF PHYSIC IN THE UNIVERSITY OF CAMBRIDGE. LONDON: PRINTED nr ADLARD AND SON, BARTHOLOMEW CLOSE. 1889. THE PROGRESS OE MEDICINE AT ST. BARTHOLOMEW'S HOSPITAL. When I was asked to give the opening address to the Abernethian Society this year I felt great difficulty in the choice of a subject. The range of medicine is wide, and of course it would have been easy to choose one of the many divisions of the science in the study of which all of us are spending our lives, but a subject of that kind, dealing with the advanced part of medical studies, is not perfectly suited to a meeting in which some of the audience have only just begun to study medicine, while others are so far advanced in it that they have already made additions to medical knowledge. Since one of the objects of the Abernethian Society is to further the advance of medicine, I have decided to endeavour to set forth the gradual progress of medicine at St. Bartholomew's, from the earliest times to the present day, as a subject likely to interest both those senior mem- bers of the Society who have ah'eady attained distinction in medical knowledge, and those junior members who are beginning their studies and ought to be encouraged to work for the day when their names may become illustrious in the history of St. Bartholomew's. I know no profession in which men are less likely to believe a thing because it has been stated for a very long time, than in that of medicine. This turn of mind, which is observable in students as well as in doctors, was almost the first thing that struck me when I came here from the 4 University. I can never remember, when I was at Cam- bridge, feeling the slightest hesitation or doubt about accepting as incontrovertible truth the statements of the distinguished persons who lectured to me on the De Falsa Legatione of Demosthenes, and the Epistle to the Colos- sians, and I was at first astonished and afterwards pleased to notice another disposition at St. Bartholomew's. A few days after coming here, I heard Sir James Paget make some remarks about a case as he went round a ward, when a student who was present differed from him on some point, and that distinguished surgeon, instead of being horror-struck at the student's presumption, took pains to prove that his own opinion was right, and on what grounds it was based. This peculiarity, I hope, will always continue to characterise students of medicine — this resolution not to accept anything which is not quite clearly put before them. This wholesome frame of mind, however, sometimes leads us to be too careless of what was done in former times. We are generally a little inclined to go too far on the side of believing in ourselves and our contemporaries, and there- fore I believe it to be of practical use for us now and then to consider how our present knowledge was acquired, as well as what it actually is, and to learn how men have reached the advanced stage in which we sometimes believe ourselves to be. The motive which has induced me to look into what has occurred in past times is that I hope from the past to learn something of actual use to us in the pi-esent. That is the reason I am anxious to lay before you to-night what is of course only a small fragment of the history of the progress of medicine in this Hospital. There is no place in England where that study may be more appropriately begun and followed up than in St. Bartholomew's Hospital. We are in the very middle of the sacred land of Medicine, and many of the great events in the history of Medicine in England are connected with the particular region in which our Hospital is, or have occurred in our Hospital itself. It has flourished as a Hospital on its present site for more than seven hundred and fifty years, and its Smithfield gateway, through which passed men of the generation whose fathers saw William the Conqueror enter London, has ever since been open to the sick poor. The College of Physicians, the first academical foundation of Medicine in England, was long situated within a few hundred yards of our gates. The founder of that illustrious College and most of its fellows for two centuries lived within a short distance of this Hospital. The place is surely appropriate to an examination of the prdgress of Medicine. How ought the inquiry to begin ? Clearly the basis of all medicine is the patient. A patient must be the very beginning, and is also the end of our study, so that I may rightly begin by endeavouring to discover who was the first patient and what was the nature of his disease who was admitted into this Hospital, and it is interesting to know that it is possible to discover the admission of a patient at a very early date. The earliest patient whose admission is recorded and whose symptoms are related is described in the life of our founder Rahere. I should recommend anyone who cares for the history of St. Bartho- lomew's to look at the manuscript when he goes to the British Museum. Anyone may get it out and examine it to his heart's content. It belonged to Sir Robert Cotton, who had in his library the busts of the Roman Emperors at the head of each of the book-cases, and the books were marked after the bust under which they happened to be placed, so this manuscript is known in the British Museum as Vespasian B.IX. This manuscript was actually written, as by comparing it with other manuscripts you may easily make sure, in the reign of Richard II. That is the period of its writing, but when you read it you will find that it is itself a copy of a manuscript of a much earlier date, composed in the reign of Henry II, within fifty years of 1123, the date of the foundation of this Hospital. It gives an account of the life of our founder, written by a man who had known those who knew Rahere, though he himself had not actually seen him. It is full of interesting particulars of the commencement of this place. In this manuscript is the account of the admission of the first patient of which we have any record. So you see there is clear and distinct documentary evidence of a patient admitted here in the reign of King Henry II. " An nothir man Adwyne by name in the towne of Dunwych 1 that dwellid on the see syde, so was contracte that he myghte nat use the free office, nethir of hande, ne of fote, his legges were clevynge to the hynder parte of his thyes, that he myghte nat goo, and his handis turnyd bakewarde, no thynge with them myght be do, ne worke : the extremyteis of his fyngers were so rigorisly contracte in the synowys, that he myght unneith put mete to his moweth. 3 In this grevous sykenes he passid his yonge age. And whan he attayned to mannys age and not yette hadde he power of his lymmys, yette sith the fame of tokenys and myracles of the blessid apostle come to hym by relacion of othir men, he began to leyfte up his sorowfull soule in to abetter hope. And thow helth were yn that tyine dilaid, it was promysed to come. The rf ore, for that he was ferre from that chirche, he yave shipmen for hyr hyyr and by shippe he was browght to the chirche, and put yn the hospitall of pore men. And ther a while of the almes of the same chirche y sustenyd. And he began yn the meyn while, by the vertu of the apostle to take breith unto hym, and he desirid helth,' by certeyn incrementys began to come ageyn ; ffirst with handys thow they were crokyd, he dyd make sniale workys as disstafes, and antell, 4 and othir wommenys instrumentys, and forthermore by succession, whan othir membrys usyd their naturall myghte he fol- lowid yn greter workys, hewerrys of wode with axe, 5 and squarerys of tymbyr with chippynge axe, 6 and nat longe 1 Iu Suffolk. ' vix ori escas porrigebat. 3 ea optata sanitas. 4 antell, percsa, weights. 5 hewerrys of wode with axe, cesores lignoruui securi. 6 et dolabra niagnis operilus imitabatur. aftir, the crafte of carpentrye, yn the same chirche, and yn the cite of London he exercisid, as it hadde be taught hym from his childehode, blessynge God, whoes yen, be oon them, that dredith hym, and uppon them that hope on his mercy." By ship he was brought to the Church, that, of course, is the Church of St. Bartholomew the Great, still standing in Smithfield, in connection with which at that time there was a Priory of Augustinian Canons. In this life there are many accounts of people who came to Rahere's tomb in the Church and believed themselves to be cured, and there is no reason to doubt that they did recover from the conditions in which they are described to have been. These cannot be reckoned as cases admitted into the hos- pital ; they were merely people who went to the church and performed their devotions there and weut away better than they came. But of this man, Adwyne, it is distinctly added he was admitted into the Hospital of poor men. By long lying in bed his muscles had become antemic and enfeebled. They evidently encouraged him in the Hospital to move his limbs a little, and he was able to move them much more than he expected ; he began to make small things, commencing with cutting and carving, and so at last was able to work again and to follow the craft of a carpenter. This is the first case of which we have any record in the Hospital, and the only admission to it mentioned in Rahere's life ; but though the condition of the patient is described no details of his treatment are given. He was discharged cured ; a fortunate beginning for our statistics. Our Founder began by building the Hospital and then went on to construct the Priory, of which St. Bartholo- mew's Church in Smithfield is the only remaining frag- ment. The Hospital was from the beginning indepen- dent, but Thomas, his successor, like Rahere himself, passed from the headship of the Hospital to that of the Priory, and the Canons profited by the proximity of a place of medical study. 8 The manuscript I have just quoted was composed in the reign of Henry II, but the oldest existing copy was made in the reign of Richard II, and it is in that very reign that the next material for the history of our medical progress is to be found. In that reign John Mirfeld, a Canon of the Priory, wrote a general treatise on medicine about the year 1380. The book is called ' Breviarium Bartholomei,' and as Mirfeld mentions cases which had occurred in his own observation there can be no doubt that he did not neglect the opportunities of the Hospital though the Priory was his proper home. The ' Breviarium Bar- tholomei ' shows what were the knowledge and practice of medicine in St. Bartholomew's when Richard II was king of England and William Wakeryng master of the Hospital. Several manuscript copies exist, of which I have examined three, but the handsomest copy of the book is that in the library of Pembroke College, Oxford. It is in Latin, and the date is indicated by a calendar for the year 1387, which is prefixed to it. It was written in the lifetime of Mirfeld, for a document of the year 1392 shows that in that year he represented the Priory in a legal proceeding. The Pembroke manuscript is in its original binding and begins with an annotated calendar. The physician of the fourteenth century " was grounded in astronomye," and needed a calendar to calculate the effect of the heavenly bodies upon his remedies and upon his patients. " Wei cowde he fortunen the ascendent Of his ymages for his pacient." Mirfeld himself often refers to the calendar, as in his chapter on injuries of the head : " The astronomers say that if any one is wounded in the head when the moon is in the constellation of the Ram his wound is seldom or never cured, unless trifling." The ' Breviarium Bartholomei ' itself begins with a finely illuminated page. In the initial is a figure of St. 9 John the Baptist in his camel-hair garment bearing a lamb in his hand ; at the foot are the arms of the Benedictine Abbey of Abingdon. This Abbey had a Hospital at its gate dedicated to St. John the Baptist, of which this medical manuscript was no doubt once the property. It probably came to Bradgates Hall, now Pembroke College, soon after the dissolution of Abingdon Abbey. At the top of the page is written in red : — Here begins the book which is called Breviarium Bartholomei, composed by the venerable man, John Mirfeld, resident in the Monastery of Saint Bartholomew in London, from which that book is named. In the beginning, says the prefatory chapter, of this compilation, as in all our works, let us give thanks to God. Memory is slippery ; this makes it wise to collect what is known of medicine into a summary. And another reason for the book is that there are so many false physicians about who commit frauds upon the public. The book is spoken of as a compilation, and this is what all the medical books of that day are. Reading was thought more important than observation, and the main part of all their chapters is what they had read or heard, with only here and there scattered passages of what they had seen. The ' Breviarium ' is divided into fifteen parts : The first, is of fevers ; the second, of affections of the whole body ; the third, of affections of the head, neck, and throat ; the fourth, of the chest and its contents ; the fifth, of the abdomen ; the sixth, of the pelvic organs ; the seventh, of the legs ; the eighth, of boils ; the ninth, of wounds and bruises ; the tenth, of fractures and disloca- tions and twists of bones ; the eleventh, of dislocations of joints ; the twelfth, of simple medicines, the list of which is gone through in alphabetical order ; the thirteenth, of compound medicines ; the fourteenth, of purgatives, and the fifteenth, of the preservation and recovery of health. The plan is that of most of the medical books of the Middle Ages. The preface is always succeeded by an 10 elaborate treatise on fevers, based upon the classification of Galen. It is curious that in his section on the pestilential fever Mirfeld does not mention the Black Death, which had raged in England so near his time. He gives, however, a pre- scription, which was probably that used by the brethren of St. Bartholomew's in that dreadful epidemic, and which was told him by brother John Helme. It was a powder made of equal parts of aloes and eastern crocus, mixed and dis- solved in warm wine slightly sweetened. The chapter on pestilence ends with a prayer to be repeated in epidemics. Cattle plague is to be warded off by a method which may be forgiven for approaching magic, since it inculcates charity. Its substance is; — That cattle shall not die all the year through. On Christmas eve let three poor travellers be entertained, and beds made up for them of hay. And let that hay be placed daily between oxen till Twelfth day, and by the goodness of God they will be safe for the whole year, as is said. — Mixed up with the medicines recom- mended for the treatment of fevers are prayers for parti- cular occasions of the disease, and these are sometimes associated with practices taken from the prevalent folk lore. A little twig of hazel, a foot long, is to be broken in the middle. The two parts are to be held a little way apart and certain words repeated, and by virtue of the words the twig becomes united in some place. Here it is to be held by finger and thumb, and the rest cut away so that there is a little cross. This the feverish man is to hold above him, and to say some words in French, and five pater nosters, and he will be healed, as has often been proved, says the ' Breviarium.' Mirfeld had certainly witnessed the long wakefulness of typhus fever. That terrible vigil in which the patient lies upon his back, with his eyes wide open, hour after hour, drawing closer and closer to death. It may well make the physician mistrust his resources. There is no superstition in Mirfeld's prayer for this season of trial, for the quflint legend of the Christians of Ephesus, who 11 outslept the age of persecution, and on waking communi- cated the ways of the primitive Church to a later genera- tion, was received as undoubted history in his day. Stand- ing by such bedsides, Mirfeld said : " Oh Lord God ! Father Omnipotent, who showedst thy holy mercy on thy seven holy youths, Maximian, Malain, Dionysius, Marai, John, Constantine, and Serapion in the City of Ephesus, whom thou madest to sleep so long. So do by thy holy love to thy servant here, that he may rest with quiet sleep, and by sleep he may grow well, with soundness of body and of mind, to glorify and praise thy holy name, which is blessed, world without end. Amen." He was not afraid to bend over the patient in close attention to his wants, and recommends that the thickly- furred tongue shall be wiped with a linen rag, moistened in acid juice. If in doubt whether the patient be still alive his prac- tice was to put a little burnt lard to the nostrils. If alive, he says, the patient thereupon scratches his nose. In Part II skin diseases are described, and couplets are often given as aids to recollect their names and symptoms. Leprosy was then common in England. The palace which gives its diplomatic name to the court of England, was then St. James's Hospital for Lepers, and there were several other foundations for them in London. It is now so rare in London that few physicians have seen more than one or two cases. A few years ago a leper was for a long time in St. Bartholomew's. His face was dread- fully deformed by the thickening of the skin, and no one could have guessed that he was only twenty-one. He had acquired the disease in Asia Minor, where he was born, and long suffering had soured his disposition. His only friend was a Manx cat, which he brought in with him, and which, on going out, he begged the sister of the ward to treat kindly for his sake. Treatment did not at all improve his case, and he confirmed a remark which, Mirfeld says, Platearius, a learned doctor of Salernum, 12 made to a friend, " I confess that all kinds of leprosy are incurable." Mirfeld himself treated leprosy, he tells us, with some success with golden pills and a restricted diet. This included bread, two parts rye and one third barley, clear, well scented wine, game ratber than flesh of domestic animals, and eggs. Cheese, pulse, hares, salt meat, and putrefied food were to be avoided. The leprosy in one of his cases was relieved for three years, but after that appeared again. The virtues of sulphur water as a remedy for scabies were known to him. Ointment made from goose-fat is one of his chief remedies for gout, and these verses show how it is to be made. " Anser sumatur Veteranus qui videatur. Post deplumeter Intralibus evacuetur Intus ponatur Que subternus noroinatur Trita caro tota Catti mox pelle remota Mel sal f uligo Faba pondere jungitur equo Unctum porcinum Thus cera? sagmen ovinum. Post hoc assatum Tunc assus non commedatur Vas supponatur Sagmen ut accipiatur. Istud pinguamen Dat gutte cuique levamen. Auseris unguentum Valet hoc super omne talentum." The fat of the badger is also recommended, and this remedy is still believed in in the north of Ireland, where I once knew a farmer on Horn Head who had a quantity of badger fat which he used to rub on painful joints. Yew and ivy juice should be mixed in the ointment according to Mirfeld. Gout was, of course, common in London in Mirfeld's 13 time, and lie may have been consulted about a gouty nun of his time, the records of whose case I have read at St. Paul's. She was of the convent of St. Helen's, Bishopsgate, and the gout prevented her from attending services in her choir. Constancia the Prioress, and Margareta the Sub-prioress, locked her up and put her on low diet. She appealed to her ecclesiastical superiors, and at last the question was decided by Pope Urban VI in 1385. His brief finally settles the case, and orders that poor Joan Heyron, the nun of St. Helen's, afflicted with gout in her hands and feet, shall be released from her vows and allowed to go out of the convent, and shall receive a pension from it for the rest of her days. Mirfeld treated chronic rheumatism by rubbing the part with olive oil. This was to be prepared with ceremony. It was to be put into a clean vessel while the preparer made the sign of the cross and said the Lord's Prayer and an Ave Maria, and when the vessel was put to the fire the Psalm, "Why do the heathen rage" was to be said as far as the verse, " Desire of Me, and I shall give thee the heathen for thine inheritance." The Gloria, Pater Noster and Ave Maria are to be said, and the whole gone through seven times. " Which done let that oil be kept." The mixture of prayers with pharmacy seems odd to us, but let it be remembered that Mirfeld wrote in a religious house, that clocks were scarce, and that in that age and place, time might not inappropriately be measured by the minutes required for the repetition of so many verses of Scripture or so many prayers. The time occupied I have tried, and found to be a quarter of an hour. Mirfeld gives a well-sounding definition of dropsy. " It is a failure of the digestive power in the liver causing distension of the limbs," but neither he nor any other medical writer had any real knowledge about the subject till after Lower, in 1669, showed that dropsy followed the obstruction of the veins of a limb. 14 One of Mirfeld's methods of treatment was a bath of willow leaves. He has many remedies for jaundice, and mentions in his account of them that he had studied at Oxford where Master Nicholas Tyngewich narrated from his professional chair how he had heard of an old woman who cured jauudice. He rode forty miles to see her and gave her a sum of money for knowledge of that cure. Here is the cure. " Take an apple and let it be divided into four parts. On the first part write + In nomine patris + ihesus + and give to the patient to eat, and if not thus cured write on the second part + et filii + nazarenus + and in the third part write + spiritus sancti + Amen. + rex judeorum + crux Cristi 4- Amen + and the first part must beforehand have been hidden where no man could find it." It is curious to note that nearly three hundred years later this method of cure is mentioned as being used by quacks and popular in London. Mirfeld often mentions English names, both of remedies and of diseases, and speaks of variola as " smal pockes." If the treatment of scrofula is not successful " we go to the king, because by touch alone kings are wont to cure that infirmity." Mirfeld condemns inebriety on hygienic grounds, but does not omit further reflections on the subject. "Drunken- ness is called the mother of all vices and faults ; it is the actual root of crimes and the origin of vices. There- fore by every Christian it is to be sedulously avoided." All through the book the curious mediasval readiness to accept any explanation of a result is apparent. The hearts of animals are not to be eaten because they cause forgetfulness. Thus some widows of Salernum who wept for their husbands made pasties of the hearts of sucking-pigs, with seasoning, and after eating the pasties forgot all about their sorrows. " Perhaps, how- ever," adds Mirfeld, without a smile, " the hearts of animals are not to be eaten because they are indigestible." 15 Part III goes on to diseases of the head and neck and throat. A mouse's head in a little bag hung by a string round the neck will keep off headache. Verses repeated in the ear are to be tried to rouse the epileptic man as he lies on the ground. The epileptic unconsciousness lasts, as has been shown by modern students of the disease, a much shorter time by the watch than it seems to a horrified onlooker, and no doubt, as Mirfeld and other writers of his time assert, the patient often got up after — " Gaspar fert mirram : thus Melchior : Balthazar aurum. Hec tria qui secum portabit nomina regum, Solvitur a morbo Domini pietate caduco " was repeated in his ea.r. To a man ignorant of the fact that while the condition which produces an epileptic fit is a temporary disturbance, that causing an apoplectic fit is one involving actual destruction of a part of the brain, it must have seemed reasonable by analogy that verses should do good to an apoplectic patient. Mirfeld recommends an empiric remedy of English Gilbert. The following two verses are to be tied round the arm, the Lord's Prayer being said the while. The verses are to be written with crosses above and below each word : + + + amara timi taturi + + + postos sigaloa sicalui + + + Ely poly carras + + + polyly pylini lyvarn + + + This must be admitted to be a charm pure and simple. 16 Toothache was treated by putting a little brandy in the hollow tooth. Mirfeld nowhere tells us who taught him, but speaks every now and then of " my master." He was once called to a woman who had lost her speech. He rubbed her palate with theodoricon emperisticon and with a little diacastorium. She recovered her speech, and bore witness to his skill. Some of his master's cases are related at great length. " An apothecary brought him a youth with a carbuncle on his face. His whole neck and throat were swelled beyond belief, and the sick man had already tokens of death ; he had no pulse and was fainting. My master said to that apothecary that the youth should go home for he was about to die in a short time. The apothecary said, ( Is there no further remedy ? ' The physician replied, ' I believe most truly that if thou mightest give tyriacum in a large dose there is a chance that he may live.' Having heard this the apothecary took him home, and was barely able to get there, and he gave to him about two drachms of tyriacum and put him to bed. His head and the affected part broke into profuse perspira- tion, and after a little there was a general perspiration, and his pulse returned. And the apothecary gave him the dose again of his own accord, and that day he was made whole except for a little sore place which afterwards healed up, and my master said that he had never seen anyone else who had recovered after being in a faint and tremor and especially without pulse." This account shows that Mirfeld's master was a regular physician, and that, like Chaucer's physician, " Ful redy hadde he hia apotecaries To sende him dragges and his letuaries." After observing truly enough that an injury on the right side of the head is likely to lead to paralysis on the left, he relates the case of one of the Canons of St. Bar- tholomew's, who was treated by his master. The Canon 17 was about to get on his horse, and when the said Canon >,ished to seat himself in the saddle that horse arose on his two hind legs, and the Canon fell head downwards over the crupper of the horse to earth. And fell so heavily upon his head that straightway he lost the sensa- tion and movement of his whole body. My master having been called by the friends of the patient, made them shave his head, and then rubbed in oil of roses with a quart of warm vinegar, and sprinkled it with a powder, and put over it a fine cloth soaked in the aforesaid oil and vinegar, and over that fastened linen stoups and bound with bandages his whole head, and put over all the skin of a lamb. And every day he visited him twice, and rubbed in ointment into his neck and as far as the middle of his spine. On the second day the patient opened his mouth a little. Then one of his friends wished to try if he would eat, but the physician would not allow it, and said, " Even if he wished to eat I would not let him." On the third day, when a question was put to him, he tried to answer, stammering, but he could not form the word. On the fourth day he spoke stammeringly, and then they handed him a thin warm drink, which he saw and swallowed. The fifth day he took a thin tisane. On the sixth day they gave him chicken broth. He then began to grow stronger, little by little, and to be able to move, but it was many days before he could walk. When he was able to take food my master began to prepare pills, to resolve by evacuation the residue of the material accumulated by the fall on his head. He recommended that he should eat the brains of birds and fowls and kids, and thus doing he was cured. But the poor Canon was never quite the same man again, as Mir- feld says : " Nunquam tamen fuit ita subtilis ingenii et bone memorie sicut prius." His master was a bold operator. My master, he says, thus operated in a case that came under his hands of the daughter of a friend of his with water accumulated in the head. This is what he did. First rubbed in sulphur 2 18 ointment twice a day, keeping a cloth of warm wool on the head ; then he tapped the head by the cautery in front. Water came out slowly. After a time he made a similar hole in the back of the head and more water came out, and in less than a year the patient was quite well. On another occasion his master was called to a man in prison, who in desperation stabbed himself, so that when he swallowed, food and drink and air came out of the wound. My master, says Mirfeld, joined the parts of the wound decently, and covered the place with powders and bandages, so that the man was cured within a month and lived. Now and then a remedy, still considered efficacious, is mentioned, as where the ' Breviarium,' quoting Avicenna, recommends turpentine for chronic bronchitis. An electuary which King Carolus used to use is recom- mended for stomach-ache, but whether this was King Charles of Naples, who lived in 1350, or King Charles II of Sicily, who died in 1300, or King Charles of Navarre, or the great Karl himself, we are not told. Several remedies rest upon the dicta of visions. A holy man in a dream told a woman of Sicily that plantago was good for enlarged lymphatic glands, and Galen him- self appeared to a certain monk and recommended colo- cynth for gout, with an external application of bdellium, cabbages, and marjoram, and assured the monk that the cure would be complete in three days. A remedy for oxen was mentioned, and further on are medicines for horses. When he gets to injuries, Mirfeld regrets that medi- cine and surgery have become separate lines of practice. Long ago, unless I mistake, he says, physicians used to practise surgery, but now-a-days there is a great difference and distinction between surgery and medicine ; and this I fear arises from pride, because physicians disdain to work with their hands, though, indeed, I myself have a suspicion that it is because they do not know how to perform par- ticular operations, and this unfortunate usage has led the public at large to believe that one man cannot know both 19 subjects ; but the well-infoimed are aware that he cannot be a good physician who neglects every part of surgery, and on the other hand a surgeon is good for nothing who is without knowledge of medicine. In the part on fractures Mirfeld is not afraid to time with precision the recovery of each broken bone. A rib will take twenty days. A humerus or a thigh bone forty days. He had noticed that union is more difficult in the aged. Dislocations were reduced with an instrument, " quod vocatur tornellus anglice wyndas." The book on simple medicines recommends the diamond, a stone born in India, for keeping off evil visions, for the diamond is hostile to the devil. Mirfeld had not tried all the experiments in chemistry which he describes. A diamond, he says, sprinkled with goat's blood can be cut with a leaden saw into as many parts as you please. The ' Breviarium ' recommends nuts as a remedy against poison, among others those in English called " Wallheno- ton." Opium, he says, is of two kinds, but the second proves to be really asafcetida. He tells a story of a trick upon travellers played with opium. A bad host used to give opium to travellers' horses. When a horse fell down as if dead he used to offer money for the skin, and when the travellers were on their way he would take vinegar, open the horse's mouth, and pour it in, and the horse would soon get up. Thus are travellers deceived. The frauds of apothecaries are mentioned ; they used to substitute the cartilage of a goat's heart for the bone found in a stag's heart. A little blessed water out of a font will stop frogs croaking in the moat. Many fully made-up prescriptions are given. How to make gruel and how to make gingerbread are told. G-ruellus anglicorum is made of coarse oatmeal with the husk off, and gingerbread, which is really toffee, of honey and ginger baked together. The receipt is : 20 Take a quart and a half of refined honey and half an ounce of Cyprus ginger, and mix them and heat gently. If the mixture is enough cooked it will grow black. If not enough you can tell by putting a knife in it and cooling it in the air. If then the bit cooled on the knife is brittle in the mouth, it is done enough. Then take it off the fire and add powder of ginger. He glories in pills with great names : The pills of the King of Sicily, the Parisian pills, the pills of the glorious King Richard, the pills of the King of England. His powders are equally grand ; the powder of Al- mansor, the powder of Patrick of Ireland, the powder of John Gaddesden, the dormitorium of Mr. John Wyke. One preparation which he mentions may justly be re- garded as the earliest preparation of our Hospital Pharma- copoeia — it must be looked upon as the ancestor of the plaster seen in the Surgery every day with " St. B. H." stamped upon it, for Mirfeld calls it " Emplastrum Bar- tholomew" This plaster is good for all wounds, whether of the head or body, also for cancers and fistulas : The receipt is : Take juice of the parsley and of the plantain and boil them, and when the liquid begins to boil add some fine wheat flour, and boil over a slow fire till thick. Add an equal quantity of honey and thicken at will. If you carry a stick of agnus castus on your travels, says Mirfeld, your feet will not get sore. Perhaps this belief is a reason why the ladies in the Flower and the Leaf are described as adorned with it, M And wreaths of agnus castas others bore." for these ladies of the leaf do not suffer fatigue and relieve the damsels of the flower who do. Another preventive of fatigue proposed in the ' Brevi- arium ' is to carry a badger's foot with you. The chapter on keeping health, which ends the book, is based upon the most famous medical book of Salernum the ' Regimen Sanitatis Salerni.' It is followed by an 21 elaborate table of contents, with the help of which it is easy to find anything in the MS. The picture is complete of the medical and surgical practice in St. Bartholomew's Hospital in the reign of Richard II. Such was fourteenth century practice ; what were the authors consulted in that age ? They are described in some lines of Chaucer's ' Prologue :' " Wei knew lie the olde Esculapius, And Deiscorides and eek Enfus, Old Ypocras Haly and Galien, Serapyon, Razis, and Av\cen, Averrois, Damascien, and Cuiistantyn, Bernard and Gatesden and Gilbertin." With the exception of ^Esculapius, for whose works Chaucer drew on his imagination, these are all physicians whose books are to be found in the library of the College of Physicians. They were constantly quoted in every medical treatise of the Middle Ages. It is quite safe to say that you would not be able to open any work of the Middle Ages without finding six of these authors at least on the page. Such was the state of medicine five hundred years ago, in the reign of Richard II. The physicians of that time read these books, and believed everything they contained, and when they wrote a fresh book they put down again what they had read. They were perfectly ready, without the slightest idea that they were not telling the exact truth, to state such facts as that you could saw a diamond under certain circumstances with a leaden saw. Such were the ways of thought of the physi- cians of those centuries — and no one seems to have risen above them. The revival of learning at last came, and an event took place in the neighbourhood of this Hospital, which was to completely alter the state of medicine in England. This was the foundation of the College of Physicians. Its first residence was in Knight Rider Street, in the neighbourhood of St. Paul's Cathedral. Soon after 22 it moved to Anien Corner, and in 1669 to Warwick Lane, and there remained until, in the reign of George IV, it moved to its present site in Pall Mall East. It was founded by Thomas Linacre, and he, with five others, formed the original College. They differed in their idea of medicine from Mirfeld. Mirfeld saw clearly that you were to do what you could for your patient, and that was Linacre's aim too, but they proposed to get at it in totally different ways. Mirfeld believed in the ancients as far as he knew them. Linacre and his College got beyond this ; they believed they could add much to the knowledge of the ancients, and though they believed what Hippocrates and Galen said was true, they did not hold it to be the whole truth, they believed that a great deal remained to be found out. That idea had not occurred to Mirfeld ; he thought the whole system of medicine was already known. The College of Physicians was founded in 1518 by Linacre, who lived in our immediate neighbourhood, and was buried in St. Paul's, and nearly every physician to St. Bartholomew's since 1518 has been a Fellow of that college. The first regular physician here was Dr. Roderigo Lopus. I might proceed to tell you something about all the physi- cians who have succeeded him, of whom I have before me a list. It would be a most interesting way of spending the evening to mention something about each of them, but I do not propose to follow it, for I wish to put before you not our whole history, but only the chief steps of our medical progress. I may, however, mention a few of the physicians : — Dr. Bright (not the person after whom the disease of the kidneys is called, for that great discoverer was a physician at Guy's Hospital) wrote rather an amusing treatise on melancholy, and was the inventor of shorthand, the first man to whom the idea occurred of taking down what was said by a series of signs. He was followed by Dr. Doyley, still remembered as a Spanish scholar, and he by Dr. Wilkinson, of Trinity College, Cambridge. Then next to him came Dr. William 23 Harvey. Then another one, a little way on, is Dr. Francis Bernard, whom, I think, we ought always to remember, for when apothecary to this Hospital he stayed in London, in this Hospital, throughout the plague. He afterwards became a physician, and I have no doubt, because of his devotion, was elected, on a vacancy, physician to the Hos- pital. And so I might go on. I think you may be a little surprised to learn how few physicians there have been on the staff of this Hospital — including the present ones, there have only been forty-nine. Here are their names and dates of appointment. All but four (Torner, Bright, Pate, Biddulph) were Fellows of the College of Physiciaus. Dr. Lopus Dr. Tomer Dr. Timothy Bright Dr. Thomas Dm ley . Dr. Ralph Wilkinson Dr. William Harvey Dr. Clarke Sir John Mieklethwaite Dr. Christopher Teartie Dr. Arthur Dacres . Dr. Francis Bernard Dr. Edward Browne . Dr. Robert Pitt Dr. Henry Levett . Dr. Salisbury Cade . Dr. William Wagstaffe Dr. Richard Tyson . Dr. Pierce Dod Dr. Win, Pitcairn Dr. Win. Barrowby (3rd) . 1750 Dr. Robert Pate Dr. Anthony Askew . Dr. Richard Tyson . Dr. John Lewis Petit Dr. David Pitcairn . . 1780 The next physician I shall mention was a resident in our Hospital but not a member of its staff. This is Dr. John Caius, a name illustrious in the University of Cam- Dr. Richard Budd . 1780 1580 Dr. John Gideon Caulet . 1784 1586 Dr. William Austin . 1786 1590 Dr. John Latham 1793 1602 Dr. Francis Biddulph 1793 1609 Dr. Edward Roberts 1794 1634 Dr. Richard Powell . 1801 1643 Dr. James Haworth . 1802 1653 Dr. Clement Hue 1823 1669 Dr. Peter Mere Latham . 1824 1678 Dr. George Leith Roupell. 1834 1682 Sir George Burrows, Bart. 1841 1697 Dr. Fred. John Farre(4th) 1854 1707 Dr. Henry Jeaffreson 1854 1708 Dr. Patrick Black . 1860 1720 Dr. Wm. Senhouse Kirkes 1864 1725 Dr. Martin 1865 1725 Dr. George Nelson Edwards 1867 1749 Dr. Francis Harris . 1868 1750 Dr. Andrew 1869 1752 Dr. Reginald Southey 1870 1754 Dr. Church 1874 1762 Dr. Gee . 1878 1774 Sir Dyce Duckworth 1883 24 bridge, and not less illustrious in the College of Physi- cians. He occupied a house within the Hospital at the annual rent of £4 a year. During Dr. John Caius' lifetime occurred one of the epidemics of what was called the sweating sickness, a curious febrile disorder first noticed in the reign of Edward IV, and frequently after- wards. Dr. Caius wrote a treatise on it, which may be called the first original treatise on medicine published in England, by which I mean the first treatise in which the modern idea of observing the disease and writing a complete account of what was actually seen was carried out. He was thoroughly versed in the expressions of Galen and Hippocrates, and of course to us many of his hypotheses seem extremely improbable, but his observa- tions are also deserving of respect. " This disease is not a Sweat onely, (as it is thought & called) but a feuer, as I saied, in the spirites by putrefac- tion venomous, with a fight, trauaile, and laboure of nature againste the infection receyued in the spirites, whervpon by chaunce foloweth a Sweate, or issueth an humour compelled by nature, as also chanceth in other sicknesses whiche consiste in humours, when they be in their state, and at the worste in certein dayes iudicial, aswel by vomites, bledinges, & fluxes, as by sweates. That this is true, the self sweates do shewe. For as in vtter busineses, bodies y' sore do labour, by trauail of the same are forced to sweat, so in inner diseases, the bodies traueiled & labored by the, are moued to the like. In which labors, if nature be strog & able to thrust out the poiso by sweat (not otherwise letted) y c perso escapeth : if not, it dieth. That it is a feuer, thus I haue partly declared, and more wil streight by the notes of the disease, vnder one shewing also by the same notes, signes, and short tariance of the same, that it consisteth in the spirites. First by the peine in the backe, or shoulder, peine in the extreme partes, as arme or legge, with a flusshing, or wind, as it semeth to certeine of the pacients, flieng in the same. Secondly by the grief 25 in the liuer and the nigh stomacke. Thirdely, by the peine in the head, and madnes of the same. Fourthly by the passion of the hart. For the flusshing or wynde commiug in the vtter and extreame partes, is nothing els but the spirites of those same gathered together, at the first entring of the euell aire, agaynste the infection therof, & flyeing thesame from place to place, for their owne sauegarde. But at the last infected, they make a grief where thei be forced, whiche comonly is in tharme or legge (the fartheste partes of theire refuge) the backe or shulder : trieng ther first a brut as good souldiers, before they wil let their enemye come further into theire dominion. The other grefes be therefore in thother partes aforsaid & sorer, because the spirites be there most pletuous as in their founteines, whether alwaies thinfection desireth to go. For fro the liuer, the nigh stomack, braine, and harte, come all the iij. sortes, and kyndes of spirites, the gouernoures of oure bodies, as firste spronge there. But from the heart, the liuish spirites. In putrifieng wherof by the euel aier in bodies fit for it, the harte is oppressed. Wherupon also foloweth a marueilous heauinesse, (the fifthe token of this disease,) and a desire to sleape, neuer contented, the senses in al partes beynge as they were bounde or closed vp, the partes therfore left heuy, vnliuishe, and dulle. Laste foloweth the shorte abidinge, a certeine Token of the disease to be in the spirites, as wel may be proued by the Ephemera that Galen writethe of, whiche because it consistethe in the Spirites, lasteth but one natural day. For as fire in hardes or straw, is sone in flambe & soue oute, euen so heate in the spirites, either by simple distemperature, or by infection and putrefaction therein conceyued, is sone in flambe and sone out, and soner for the vehemencye or greatnes of the same, whiche without lingering, consumeth sone the light matter, contrary to al other diseases restyng in humoures, wherin a fire ones kindeled, is not so sone put out, no more then is the same in moiste woode, or fat Sea coles, as well by the particular Example 26 of the pestilence, (of al others most lyke vuto this) may be declared, whyche by that it stadeth in euel humors, tarieth as I said, sometyme, from iiij. vii. ix. & xj. vntill xiiij. dayes, differentlie from this, by reason therof, albeit by infection most lyke to this same. This vnder one laboure sbortelie I haue declared — both what this disease is, wherein it consisteth, howe and with what accidentes it grieueth and is differente from the Pestilence, and the propre signes, and tokens of the same, without the whiche, if any do sweate, I take theym not to Sweate by this Sickenesse, but rather by feare, heate of the yeare, many clothes, greate exercise, affection, excesse in diete, or at the worst, by a smal cause of infection, and lesse disposi- tion of the bodi to this sicknes. So that, insomoche as the body was nat al voide of matter, sweate it did when infection came : but in that the mattere was not greate, the same coulde neyther be perilous nor paineful as in others, in whom was greater cause." You see he has tried to describe what he observed, and if you separate it from the phraseology of his time — which did not in any way spoil his observation — he has clearly told from personal observation the onset and progress of the disease. He says it is true it is rather like the syrocbus of Galen, but all the same gives a clear descrip- tion from what he had himself seen. It was in all pro- bability a violent kind of influenza. Now, Dr. Caius was a most learned man, and he believed that in Galen much truth was to be found. He believed that what the ancients said was true and of authority, but he also believed that there was a great mass of medicine to be found out by observing patients and by describing their symptoms, and by examining their bodies after death, and he entirely rejected all the compiling authors of the middle ages. He and the physicians of the College thought that Hippocrates and Galen were always right, but that much was to be learned from our own individual observation, and they approached the belief that more was to be learned at the bedside than in the library. This was 27 a great advance. Dr. Caius continued to live in St. Bartholomew's Hospital for many years. The first dinner — the first banquet of the College of Physicians — was held at this Hospital in Dr. Caius' house in 1554. At the present day, when the President of the College of Physi- cians takes the chair at the comitia majora of the College, a meeting which consists of the President and all the Fellows, he bears in his hands, as a sign that the meeting has begun, a silver sceptre, on the top of which are four little serpents. This sceptre was made at the expense of Dr. Caius, and after it was made the College had this dinner at Dr. Caius' house in this Hospital. Dr. Caius died in 1573. Shortly before the year 1609 Dr. William Harvey came to this Hospital from Cambridge. Harvey was a physician of the same kind as Caius, and I think we ought to remember low very much Caius did towards encouraging the study which led to the great discovery of the circulation of the blood by Harvey. Caius left money so that there should always be dissec- tion of the human body, the actual study of anatomy going on at the College of Physicians and at Cambridge, and it was that opportunity of knowledge while at the University that made Harvey such a proficient in anatomy as he actually was. So it was Dr. Caius who was the means of leading Harvey to his discovery. Harvey gave in 1616 the lectures at the College of Phy- sicians in which the circulation of the blood was first announced. It is worth considering well what kind of a physician Harvey was, for he is certainly by far the most illustrious person who has been on the staff of this Hos- pital, and the one who has done most to further the progress of medicine. What stage had he reached in the course of medical progress ? If you look at the biographies of Harvey — many of them are careless — you see it stated that it is doubtful whether he was a great physician in his own time. There is no ground for this assertion : he certainly was a great physician — his object in life was the treatment of patients ; 28 literature as well as science interested him ; but his whole wish and desire was to learn to cure disease, and the statement that Harvey was not thought distinguished in his profession in his own time can be traced to a remark of a non-medical writer of the period, Mr. Aubrey, who wrote a gossiping volume of personal recollections. If you look into Harvey's works, his lectures on anatomy and his book on the circulation of the blood, you will find that he was first of all, and all through his life, a physician anxious to cure patients. Like Linacre and Caius he had great respect for the ancients. He thought Galen worth careful study. A few weeks ago I had to go to the British Museum for something else, and happening to take out a copy of Galen noticed that it had upon it notes by Harvey, undoubtedly in Harvey's hand- writing. Now, Harvey had a habit, when he wrote down what he thought original, of putting his own initials, " W. H.," against it. In this Galen, Harvey has thus placed his initials after several manuscript notes. He had studied Galen carefully, and all these treatises are carefully annotated throughout in his handwriting. It would not have needed this, however, to assure us he was deeply versed in ancient medicine, for in his lectures he often refers to all the old authors. He had thought deeply over Aristotle ; and in one lecture he says that it was a passage of Aristotle which first suggested to him the idea of the circulation of the blood. The medical authors so often quoted by Mirfeld are never mentioned by Harvey. Taking Harvey's lectures on anatomy — of which the manuscript was published in 1886 — much may be learnt of his medical attainments. They do not read continuously, they are the actual notes of his lectures, written largely in Latin, and partly in English. He was lecturing on anatomy, so he only used medicine as an illustration ; and no doubt what he ac- tually said was much more full than what is left in writing. To take his account of the liver as an example ; he describes ten conditions which are all now well known 29 to us. He does not explain their pathology, but by de- scribing them he made the first step in the direction of explanation, and his remarks on the liver are a fair example of how rich in observation his notes are. It is worth while to interpret his quaint expressions. (1) " Item russetish Ingentem et durum plane scirrus tumor absque pene sanguine aspera superficie." This russet-coloured, large, hard, scirrhus-like, bloodless liver with a rough surface, we should call a case of cir- rhosis. (2) " Between russet and purple as big as an ox liver Jhon Bracey extentum," was probably an amyloid liver. (3) " Begining to be discolored Joan Johnson mortua ex febre maligna," was the swollen liver of raised tem- perature. (4) " Palish dirty color cum mucca on ye coat. Hydrope resudante materia little blathers or tanquam blisters," is the liver of general peritonitis. (5) " Like a heap of pus colore subfavescum noe shape nor particle remayninge Jecoris," was probably a large abscess of the liver. (6) " Ut plurimum ubi in Hydrope vel alias ubi Jecur russetish splen watchet greenish or lead color si morbo ex cachexia," describes the thickening of the capsule often found after death with chronic peritonitis. (7) "Apostema ingens per multos menses ex pure fcetidissimo 2 or 3 gallons et aqua cum viscosit panni- culis convolutis as glew stepened in water or Isonglass : regressum Hospitali." The little sticky rags like glue or isinglass and the large quantity of fluid show clearly that he is describing a great hydatid cyst filled with fluid and daughter cysts. (8) " Mortua Inflammatio Jecoris of a botch in tunica red hard cancerous." This botch was a mass of new growth. (9) " Absessulaa ut cuniculis." 30 This was probably a liver of pyaemia with many small abscesses. (10) " Extenuato cum felle magis disfcentum ut urina et calculis referto ab ictero." This liver distended with thin watery bile and with gall-stones was of the form of cirrhosis due to long- continued obstruction of the common duct. These are ten distinct and most important observations on the condition of the liver. If you compare these observations of his with any earlier works you will see that Harvey really belonged to our time, and that in his opinion you are to learn how diseases are produced not only by poring over books but by examining the body after death, and comparing the anatomical appear- ances with the symptoms observed during life. The physician to St. Bartholomew's in Harvey's time, learned and valuable as he was, did not do all the work of the Hospital ; on the contrary, a great part of the laborious work of the Hospital was done by a man who was not thought distinguished enough to come as a guest to the dinner at Dr. Caius' house, though they had him in after dinner to warn him what he must not do, and that man was the surgeon. He was a member of a company in the City of London which for a long time had a hard struggle to live among the companies, and he practised an honest occupa- tion and hoped always " to hold himself as a good artist." But he was in a very subordinate position in the Hospital, and had very few opportunities of improving himself with the learned persons of his time ; and the next step I wish to point out to you is how the surgeon came to improve himself. He was not even allowed to see the prescrip- tions, for they were carefully locked up. He nevertheless took to observing — observation of patients had been set before mankind as the way to find out about disease. The surgeons took earnestly to observing. The physicians for several centuries had been reading, and then came to observing at St. Bartholomew's, but you will notice that the surgeons had read very little, and began to observe 31 before they had read much. Of course, they knew how to read, but were not learned book men. At last the time came when there appeared a really learned surgeon, a surgeon who had not only observed but read. That surgeon was Charles Bernard, who worked here from 1686 to 1710. He was surgeon to Queen Anne, and had one of the finest libraries of his time. The College of Physicians possess some of his books, and in one of the books now in the library there is written his name, Caroli Bernard : Chir : Lond : in his own handwriting. He was not only well read but was one of the best observers of his profession. I believe it is to him we owe first the observation that new growths are likely to recur, and this ought to be remembered in connection with his name. He was a person of extraordinary learning and pleasant conversation, and Swift mentions his death with regret. He was the scientific ancestor of the learned surgeons who since his time have continued to flourish here — Pott, Abernethy, Lawrence, with those no less dis- tinguished ones who flourish at the present day, and whose names are so well known to you. From Bernard's time there ceased to be any great difference in culture and distinction between the members of the Staff, and in that very period, in the time of Charles Bernard, an observation was made here by a frequenter of the Hospital, a person buried in St. Andrew's, Holborn, of whom we have all heard, though when I tried to learn exactly who he was from several anatomists, I could not learn from them his Christian name, when he lived, or anything about him. This person was Douglas, after whom the fold of Douglas is called. Douglas was a physician in London, and he constantly attended this Hospital, and went round the wards. In ] 716 he describes very clearly in a paper in the ' Philosophical Transactions,' the general appear- ances of amyloid disease of the spleen, but not, of course, the appearance produced by adding iodine, in a case of marasmus with strumous enlargement of the lymphatics. 32 This was not a very thorough discovery ; but another thing he made out is very much more remarkable. He says that while he was going round the Hospital of St. Bartholomew he saw a young man suffering from palpita- tion, and that as his heart beat he could hear a distinct sound with the beating of his heart. The man died and Douglas describes how at the post-mortem he saw the heart was enormously enlarged, and the aortic valves were contracted and hard so as to allow the blood to flow back into the ventricle. He had thus discovered the murmur caused by aortic disease a hundred years before the stethoscope came to make such observation easy. This, then, was a great step in medicine actually made in the wards of this Hospital. Another step made a little later in the century ought always to be remembered here, although it may seem slight now-a-days, and that is Dr. David Pitcairn's discovery that inflammation of the valves of the heart is common in rheumatic fever. I have tried to give you some information of what the progress of medicine has been in St. Bartholomew's, — of a few of its important steps. I have shown you what were the medical ideas when the Hospital began : you know yourselves what our present state of knowledge is. I have, of course, not described every improvement which has taken place but have only pointed out some of the more important steps which have led to our present condition. I have described how the physician grew from a school- man into a scientific observer, and how the surgeon ap- peared on the scene in livery and without learning and grew from a handicraftsman to be a man of science. Two other actors in this history remain to be mentioned. First of all the actual student of medicine, a person to whom, I believe that, in our own time, the progress of medicine is enormously due. You will remember that Dr. Thomas Young, who was the originator of the undula- tory theory of light, made one of his discoveries while a student here, before he was twenty years of age, and that he was elected a Fellow of the Royal Society while 33 a student here. Another student — a member of this Society — discovered trichina spiralis in muscles. He is now well known to all the world as Sir James Paget. But these were great and exceptional students, and when I spoke of the value of students to the advancement of medicine I was thinking rather of the influence which all students exercise on their teachers, the physician and the surgeon. The students' criticism must always make observation so much more careful, and statement so much more measured than if they were absent, that their presence is invaluable to the patients as well as to the physicians and surgeons. I believe it is largely to this influence that the great progress of medical observation in recent times has been due. You will see in our calendar a short preface, relating how students began here soon after 1660, but it is incomplete and does not carry the record far enough back. Harvey himself studied here early in the reign of James I, and it was the custom of men who wished to study medicine to go into the wards and pick up a little, though not to work systematically as they do now. There is one other class of persons who have been added to our medical life, and who are an important addition to our means of treating patients. These, of course, are the nurses. When Dr. Caius lived here there was in every ward, as at the present day, a sister, but her chief business was to maintain order, and to see that the patients spun the proper amount of flax, and to take care that the yarn delivered to her bore a just proportion to the thread that went out. From that to our present elaborate system of nursing is a great change. The pro- gress in this direction has been very rapid in the last few years, and it has now reached the conclusion, which one would have thought it would have reached before, that careful education and training produce more useful nurses than chance. The result is that the directions of the physicians and surgeons are carried out in a way which was unknown before. 3 34 I have tried to show you how the Hospital began to treat patients. First of all we had men like Mirfeld, who looked into old treatises and compiled new ones, rearrang- ing old information, and never correcting it by systematic observation ; who sometimes made a sensible remark but never added to knowledge. Then came men like Dr. Caius and Harvey, who believed in ancient learning, but made original observations and looked to observation as the means of advancing medicine, so that from their day discoveries have continuously been made here. Thus the patient, with whom we began as the foundation of all, has led to the creation of the physician, of the educated surgeon, of the careful and observing student, and of the well-trained nurse ; and that is the history of the progress of medicine in St. Bartholomew's Hospital. I should be sorry if I left you with any but very kindly feeling for the times and the men under whom seven hundred and fifty years ago our Hospital began. Their whole object was the relief and cure of patients. They desired to do all in their power for the sick man. In the midst of increased knowledge, of increased means of observation, of deeper interest in the phenomena of disease for their own sake, let us never forget that to do all we can for patients is the true end of medicine. PKINIKD BY ADLABD AND 60W, BARTHOLOIIBW CLOSE, B.C. Date Due Demco 293-5 LSI Sou 2. 2. Accession no. HC Author Moore, Sir N. Progress of medicine at St. Bart's. Call no. Gt„ .Brit..